Prevalence of High Blood Pressure and Associated Factors among a Population of Apparently Healthy in-School Adolescents in Delta State, Nigeria: A Cross-Sectional Survey.

BACKGROUND: Adolescence is a vulnerable phase when risky behaviours like smoking, poor diet, and physical inactivity set the stage for health problems like hypertension. OBJECTIVE: This study assessed the prevalence of high blood pressure (HBP) and associated factors among apparently healthy inschool adolescents in Delta State, Nigeria. METHODS: A cross-sectional study was conducted among apparently healthy in-school adolescents aged 10 to 19 years, using a multi-stage random sampling technique. HBP was defined using the 2016 European Society of Hypertension Guidelines. Factors associated with HBP were determined using binary logistic regression. A p-value less than 0.05 was taken as significant. RESULTS: Of the 574 participants surveyed, 331 (57.7%) were females and 243 (42.3%) were males, with a female-to-male ratio of 1.36. The mean age of the study participants was 14.7 years. The mean systolic and diastolic blood pressure of the study participants were 118.81 (±12.703) and 70.16 (±9.972) mmHg respectively. Prehypertension and hypertension were present in 14.8% and 18.3% of the study population, respectively. Age 10-13 years (AOR = 7.70; 95% CI: 2.26-26.22; p = 0.001) and 14-16 years (AOR = 4.62; 95% CI: 1.40 -15.25; p = 0.001), upper socioeconomic status (AOR=1.19; 95% CI: 0.57-2.48; p = 0.020), and obesity (AOR = 2.14; 95% CI: 1.08-4.25; p = 0.039) were factors associated with HBP. CONCLUSION: The prevalence of hypertension among the study participants was significant. Factors associated with HBP include younger age (specifically 10-16 years old), higher socioeconomic status, and obesity.

CONTEXTE: L'adolescence est une phase vulnérable où des comportements à risque tels que le tabagisme, une alimentation déséquilibrée et l'inactivité physique posent les bases de problèmes de santé comme l'hypertension. OBJECTIF: Cette étude a évalué la prévalence de l'hypertension artérielle (HTA) et les facteurs associés chez des adolescents scolarisés apparemment en bonne santé dans l'État du Delta, Nigéria. MÉTHODES: Une étude transversale a été menée parmi des adolescents scolarisés apparemment en bonne santé âgés de 10 à 19 ans, en utilisant une technique d'échantillonnage aléatoire à plusieurs degrés. L'HTA a été définie selon les directives de 2016 de la Société Européenne d'Hypertension. Les facteurs associés à l'HTA ont été déterminés à l'aide d'une régression logistique binaire. Une valeur p inférieure à 0,05 a été considérée comme significative. RÉSULTATS: Parmi les 574 participants interrogés, 331 (57,7 %) étaient des filles et 243 (42,3 %) des garçons, avec un ratio fille/garçon de 1,36. L'âge moyen des participants à l'étude était de 14,7 ans. La pression artérielle systolique et diastolique moyennes des participants étaient respectivement de 118,81 (±12,703) et 70,16 (±9,972) mmHg. La préhypertension et l'hypertension étaient présentes chez 14,8 % et 18,3 % de la population étudiée, respectivement. L'âge de 10 à 13 ans (ORaj = 7,70 ; IC à 95 % : 2,26-26,22 ; p = 0,001) et de 14 à 16 ans (ORaj = 4,62 ; IC à 95 % : 1,40-15,25 ; p = 0,001), un statut socio-économique élevé (ORaj = 1,19 ; IC à 95 % : 0,57-2,48 ; p = 0,020) et l'obésité (ORaj = 2,14 ; IC à 95 % : 1,08-4,25 ; p = 0,039) étaient des facteurs associés à l'HTA. CONCLUSION: La prévalence de l'hypertension parmi les participants à l'étude était significative. Les facteurs associés à l'HTA incluent un âge plus jeune (en particulier entre 10 et 16 ans), un statut socio-économique élevé et l'obésité. MOTS-CLÉS: Adolescents, Hypertension artérielle, Obésité.

Cost-effectiveness analysis along the continuum of HIV care: how can we optimize the effect of HIV treatment as prevention programs?

The cascade of HIV care has been proposed as a useful tool to monitor health system performance across the key stages of HIV care delivery to reduce morbidity, mortality, and HIV transmission, the focal points of HIV Treatment as Prevention campaigns. Interventions to improve the cascade at its various stages may vary substantially in their ability to deliver health value per amount expended. In order to meet global antiretroviral treatment access targets, there is an urgent need to maximize the value of health spending by prioritizing cost-effective interventions. We executed a literature review on economic evaluations of interventions to improve specific stages of the cascade of HIV care. In total, 33 articles met the criteria for inclusion in the review, 22 (67 %) of which were published within the last 5 years. Nonetheless, substantial gaps in our knowledge remain, particularly for interventions to improve linkage and retention in HIV care in developed and developing-world settings and generalized and concentrated epidemics. We make the case here that the attention of scientists and policymakers needs to turn to the development, implementation, and rigorous evaluation of interventions to improve the various stages of the cascade of HIV care.

Suboptimal use of HIV drug resistance testing in a universal health-care setting.

HIV drug resistance testing is recommended as routine part of clinical practice in HIV/AIDS treatment and care. Our objective is to assess the determinants of accessing HIV drug resistance testing and examine the factors associated with resistance testing prior to or after starting highly active antiretroviral therapy (HAART) in a setting where access to HIV care is free and universal. The Longitudinal Investigation into Supportive and Ancillary health services (LISA) study is an open prospective cohort of HIV-positive persons on HAART in British Columbia (BC), Canada. Non-clinical data were collected through an interviewer-administered survey and clinical data were obtained through the BC Centre for Excellence in HIV/AIDS Drug Treatment Program. Independent associations between key explanatory variables and resistance testing were analyzed using logistic regression. We restricted our post-HAART analyses to those patients who met the criteria for resistance testing after HAART initiation. Of 359 LISA participants who started HAART after 2000 and at a time when resistance testing was available free of charge, almost half did not receive a baseline resistance test. Post-HAART initiation, 165 of 359 study subjects met the criteria for resistance testing based on current therapeutic guidelines due to virological failure. About 37.6% of them remain untested for resistance. Multivariable analyses show that baseline testing was less likely performed for persons of Aboriginal ethnicity and more likely performed for patients initiating HAART in 2004 or after. Additionally, persons initiating HAART in 2004 or after were less likely to have received a resistance test after virologic failure. Our results show that despite existing clinical guidelines, resistance testing is underused, even in an environment where the service is available free of charge. Further, resistance testing is particularly underutilized among vulnerable populations. Urgent efforts are needed to ensure the optimal use of resistance testing at baseline and at the time of virologic failure as recommended by current guidelines.

Efficacy and safety of statin treatment for cardiovascular disease: a network meta-analysis of 170,255 patients from 76 randomized trials.

BACKGROUND: Statins represent the largest selling class of cardiovascular drug in the world. Previous randomized trials (RCTs) have demonstrated important clinical benefits with statin therapy. AIM: We combined evidence from all RCTs comparing a statin with placebo or usual care among patients with and without prior coronary heart disease (CHD) to determine clinical outcomes. DESIGN: We searched independently, in duplicate, 12 electronic databases (from inception to August 2010), including full text journal content databases, to identify all statin versus inert control RCTs. We included RCTs of any statin versus any non-drug control in any populations. We abstracted data in duplicate on reported major clinical events and adverse events. We performed a random-effects meta-analysis and meta-regression. We performed a mixed treatment comparison using Bayesian methods. RESULTS: We included a total of 76 RCTs involving 170,255 participants. There were a total of 14,878 deaths. Statin therapy reduced all-cause mortality, Relative Risk (RR) 0.90 [95% confidence interval (CI) 0.86-0.94, P ≤ 0.0001, I(2)=17%]; cardiovascular disease (CVD) mortality (RR 0.80, 95% CI 0.74-0.87, P<0.0001, I(2)=27%); fatal myocardial infarction (MI) (RR 0.82, 95% CI 0.75-0.91, P<0.0001, I(2)=21%); non-fatal MI (RR 0.74, 95% CI 0.67-0.81, P ≤ 0.001, I(2)=45%); revascularization (RR 0.76, 95% CI 0.70-0.81, P ≤ 0.0001); and a composite of fatal and non-fatal strokes (0.86, 95% CI 0.78-0.95, P=0.004, I(2)=41%). Adverse events were generally mild, but 17 RCTs reported on increased risk of development of incident diabetes [Odds Ratio (OR) 1.09; 95% CI 1.02-1.17, P=0.001, I(2)=11%]. Studies did not yield important differences across populations. We did not find any differing treatment effects between statins. DISCUSSION: Statin therapies offer clear benefits across broad populations. As generic formulations become more available efforts to expand access should be a priority.